HIV epidemic and national response in Portugal under financial constraints and a comparative analysis with three southern european countries

Introdução: A presente agenda global de saúde para o VIH/SIDA visa mobilizar os países de todo o mundo para enfrentar as principais lacunas na resposta ao VIH. A ONUSIDA estabeleceu metas ambiciosas para o tratamento do VIH para serem atingidas até 2020. A OMS recomenda que abordagens baseadas na evidência e estratégias inovadoras, incluindo a profilaxia pré-exposição (PrEP) e o autoteste de VIH, façam parte das respostas nacionais à epidemia de HIV. Este compromisso global sem precedentes foi lançado após uma grave crise financeira global, que forçou muitos países a reduzir a despesa em saúde. Este estudo teve como objetivo analisar os potenciais efeitos desses constrangimentos financeiros na resposta e políticas nacionais para o VIH em Portugal, no contexto de outros países do sul da Europa que também receberam programas de assistência financeira. Métodos: Para os objetivos deste estudo, foram realizadas quatro análises, utilizando diferentes abordagens metodológicas: a) Foi utilizado um modelo hierárquico de regressão de Poisson com efeitos aleatórios para analisar a relação entre o tempo de internamento e variáveis do doente, dos cuidados de saúde e do contexto, utilizando dados nacionais de 20,361 internamentos ocorridos entre 2009 e 2014 em 41 hospitais públicos em Portugal; b) Para o período 2009-2018, foram analisados os resultados dos programas de prevenção do VIH em Portugal: apoio financeiro a organizações privadas sem fins lucrativos, programa de troca de seringas, teste rápido de VIH e distribuição de materiais preventivos; c) Para o período 2005- 2017, foram analisados os dados de vigilância de do VIH/SIDA em Portugal, usando análise descritiva e modelos de regressão linear para testar tendências nos novos diagnósticos de VIH e SIDA e diagnósticos tardios de VIH; d) Foram examinados e comparados um conjunto de indicadores de VIH no Chipre, Grécia, Portugal e Espanha, países que receberam assistência económica da União Europeia durante a crise financeira. Resultados: Este estudo constatou que o tempo de internamento dos doentes com VIH/SIDA entre 2010 e 2014 nos hospitais públicos portugueses foi significativamente menor em comparação com 2009, e que diversas variáveis, incluindo sexo feminino, internamento urgente, mortalidade hospitalar, pneumonia pneumocystis, hepatite C, e o rácio de liquidez do hospital contribuiu para a diminuição do tempo de tempo de internamento dos doentes com VIH/SIDA entre 2009 e 2014. Este estudo também mostrou que, apesar dos cortes transitórios de despesa em 2012-13, o Programa Nacional para a Infecção VIH e SIDA conseguiu melhorar a sua eficiência e manter as suas actividades principais, graças à priorização de gastos na expansão do teste de VIH e a um forte envolvimento com organizações da sociedade civil. A análise das tendências do VIH entre 2005 e 2017 mostrou uma redução significativa das novas infecções em todos os grupos, excepto nos homens que têm sexo com homens (HSH), onde foi observada uma tendência de aumento não significativa. O diagnóstico tardio ainda é comum em todos os grupos de transmissão, excepto nos HSH, enquanto a aquisição de VIH no estrangeiro é relevante entre pessoas nascidas fora de Portugal, excepto entre utilizadores de drogas. A análise comparativa com outros três países do sul da Europa que receberam assistência económica mostra que Portugal é o único país que implementou PrEP e autoteste de VIH. Portugal atingiu as metas 90-90-90 da ONUSIDA para o tratamento do VIH em 2017. Conclusão: Os resultados deste estudo mostram que os constrangimentos financeiros com que Portugal se defrontou não prejudicaram o progresso do país em relação à eliminação da SIDA até 2030, tornando Portugal um estudo de caso interessante no contexto europeu.Background: The current global health agenda for HIV/AIDS aims to mobilise countries worldwide to address major gaps in HIV response. UNAIDS has set ambitious targets to HIV treatment to be met by 2020. WHO recommends that evidence-based approaches and innovative strategies, including pre-exposure prophylaxis (PrEP) and HIV selftesting (HIVST), should be part of countries’ response to the HIV epidemic. This unprecedented call for a global commitment against HIV/AIDS came in the aftermath of a severe global financial crisis that forced many countries to cut health care spending. This study aimed to analyse the potential effects of these financial constraints on the response to HIV/AIDS and associated national policies in Portugal, in the context of other Southern European countries that also received bailout programmes. Methods: For the purposes of this study, four analyses were conducted, using different methodological approaches: a) Hierarchical Poisson regression model with random effects was used to analyse the relation between length of stay and patient, treatment and setting characteristics, using national data from 20,361 hospitalizations occurring between 2009 and 2014 in 41 public hospitals in Portugal; b) For the period 2009-2018, we analysed the outcomes of HIV prevention programmes in Portugal which included: financial support to private non-for-profit organisations; syringe exchange programme; HIV rapid testing; and distribution of preventive materials; c) For the period 2005-2017, we analysed Portuguese HIV/AIDS surveillance data, using descriptive analysis and linear regression models to test for trends in new HIV and AIDS diagnoses and late HIV diagnoses; d) We examined and compared a set of HIV indicators in Cyprus, Greece, Portugal and Spain, countries which received economic assistance from the European Union during the financial crisis. Results: This study found that length of stay of HIV/AIDS patients in Portuguese public hospitals between 2010 and 2014 was significantly shorter compared to 2009, and that a number of variables, including being female, urgent admission, in-hospital mortality, pneumocystis pneumonia, hepatitis C, and hospital's current ratio contributed to the decrease of HIV/AIDS patients’ length of stay between 2009 and 2014. Findings also showed that, despite transitory spending cuts in 2012-13, the Portuguese HIV/AIDS Programme was able to improve its efficiency and sustain its core activities, thanks to prioritisation of spending in HIV testing expansion and a strong engagement with civil society organisations. The analysis of HIV trends between 2005 and 2017 has shown a significant decline in new HIV infections in all groups, except in men who have sex with men, where a non-significant increase trend was observed. Late diagnosis remains common in all transmission groups, except in MSM, while foreign acquisition of HIV is relevant among foreign-born persons, except in people who inject drugs. The comparative analysis with other three Southern European countries that received economic bailout assistance shows that Portugal is the only country that implemented both PrEP and HIVST. Portugal met the UNAIDS 90-90-90 targets for HIV treatment in 2017. Conclusion: Results from this study show that financial constraints experienced in Portugal have not hampered the country’s progress towards eliminating AIDS by 2030, making Portugal an interesting case study in the European context

A baseband wireless spectrum hypervisor for multiplexing concurrent OFDM signals

The next generation of wireless and mobile networks will have to handle a significant increase in traffic load compared to the current ones. This situation calls for novel ways to increase the spectral efficiency. Therefore, in this paper, we propose a wireless spectrum hypervisor architecture that abstracts a radio frequency (RF) front-end into a configurable number of virtual RF front ends. The proposed architecture has the ability to enable flexible spectrum access in existing wireless and mobile networks, which is a challenging task due to the limited spectrum programmability, i.e., the capability a system has to change the spectral properties of a given signal to fit an arbitrary frequency allocation. The proposed architecture is a non-intrusive and highly optimized wireless hypervisor that multiplexes the signals of several different and concurrent multi-carrier-based radio access technologies with numerologies that are multiple integers of one another, which are also referred in our work as radio access technologies with correlated numerology. For example, the proposed architecture can multiplex the signals of several Wi-Fi access points, several LTE base stations, several WiMAX base stations, etc. As it able to multiplex the signals of radio access technologies with correlated numerology, it can, for instance, multiplex the signals of LTE, 5G-NR and NB-IoT base stations. It abstracts a radio frequency front-end into a configurable number of virtual RF front ends, making it possible for such different technologies to share the same RF front-end and consequently reduce the costs and increasing the spectral efficiency by employing densification, once several networks share the same infrastructure or by dynamically accessing free chunks of spectrum. Therefore, the main goal of the proposed approach is to improve spectral efficiency by efficiently using vacant gaps in congested spectrum bandwidths or adopting network densification through infrastructure sharing. We demonstrate mathematically how our proposed approach works and present several simulation results proving its functionality and efficiency. Additionally, we designed and implemented an open-source and free proof of concept prototype of the proposed architecture, which can be used by researchers and developers to run experiments or extend the concept to other applications. We present several experimental results used to validate the proposed prototype. We demonstrate that the prototype can easily handle up to 12 concurrent physical layers

On the distribution of an effective channel estimator for multi-cell massive MIMO

Accurate channel estimation is of utmost importance for massive MIMO systems to provide significant improvements in spectral and energy efficiency. In this work, we present a study on the distribution of a simple but yet effective and practical channel estimator for multi-cell massive MIMO systems suffering from pilot-contamination. The proposed channel estimator performs well under moderate to aggressive pilot contamination scenarios without previous knowledge of the inter-cell large-scale channel coefficients and noise power, asymptotically approximating the performance of the linear MMSE estimator as the number of antennas increases. We prove that the distribution of the proposed channel estimator can be accurately approximated by the circularly-symmetric complex normal distribution, when the number of antennas, M, deployed at the base station is greater than 10

political arguments from the left and right

Funding Information: The authors with to thank FCT (Fundação para a Ciência e Tecnologia) for funds to GHTM – UID/. Publisher Copyright: © 2020 Elsevier B.V.The Portuguese National Health Service (NHS) was established in 1979. Since its inception, the relationship of the NHS with private-for-profit and private-non-profit organisations has been controversially discussed between left and right-wing political parties, and this has also led also to academic debate. In 1990, a Health Basic Law was approved by right-wing parties, which allowed public-private partnerships (PPPs) in the health system and led to an increased role of the private sector in health care provision. During the 2015 general elections, the role of PPPs in the health system was an important topic of discussion, with all left-wing parties calling for an end of PPPs in the NHS. In 2019, after two years of intense political controversies, left-wing parties supporting the minority socialist government approved a new Health Basic Law. This paper analyses the process of policy formulation, tracing the process of adoption and the views of the main political parties involved. Although some parties wished to eliminate PPPs and to mandate that services in the NHS should be provided exclusively by public providers, this was not included in the final version of the law. Nevertheless, the new Health Basic Law re-enhances the central role of the NHS in the health system, clarifying that the private and non-profit sectors should only play a complementary role.publishersversionpublishe

Portuguese health care providers’ knowledge, attitudes, and acceptability of HIV pre-exposure prophylaxis

Introduction: Evidence shows that pre-exposure prophylaxis (PrEP) is highly effective in preventing sexually acquired human immunodeficiency virus (HIV) infection. Whilst its implementation is limited to the US and some countries where demonstration projects have taken place, PrEP has recently been introduced in Portugal. Successful implementation of PrEP requires actively engaging and involving of health care providers (HCP) in Portugal, yet little is known about their knowledge, attitudes, and acceptability towards this novel intervention. Material and methods: An online survey of convenience-sampled Portuguese HCP was conducted in January 2016, prior to PrEP implementation, to determine their knowledge, attitudes, practices, and acceptability of PrEP. Results: A total of 96 respondents nationwide took part in the study, of whom the majority were females (60.3%), specialist physicians/junior doctors (39%/53%), working in the field of HIV for 1 to 5 years (42.3%). Over half (51%) considered having an average or high knowledge of PrEP, and this was more common amongst infectious diseases specialists. Major concerns regarding PrEP implementation included a rise in sexually transmitted infections and increased antiretroviral resistance. Despite only 31.3% being asked about PrEP in the future, the majority (75%) considered that PrEP should be made available in Portugal. The main barrier to PrEP implementation was the lack of knowledge and information to HCP. Conclusions: Portuguese HCP demonstrated variable degrees of knowledge around PrEP, yet most would support its introduction in the country. Concerns were raised about potential consequences of PrEP roll out as well as implementation challenges that ought to be addressed before PrEP introduction.info:eu-repo/semantics/publishedVersio

Globalisation, curriculum et apprentissage. Pour une analyse critique des pratiques curriculaires en contextes différenciés

Tendo como ponto de análise as políticas viajantes, cujo processo de regulação se observa pela mudança conceitual, analisamos, neste texto, os conceitos-chave de globalização, currículo e aprendizagem, num contexto de análise crítica das práticas curriculares em contextos diferenciados, sobretudo da educação de infância e da educação em situações de necessidades educativas especiais. Porque o currículo é um processo de educação e formação, com perspetivas muito diferentes, que cada vez mais tem a sua construção de base no contexto da globalização, entendida como processo de homogeneização ao nível de similaridades definidas pelas políticas transnacionais, como se diferencia a aprendizagem ao nível das práticas curriculares? Para respondermos a esta interrogação, seguimos a análise documental, com relevo para documentos estruturantes da organização curricular portuguesa e planificações utilizadas pelos docentes ao nível da educação de infância, das necessidades educativas especiais e de um contexto institucionalizado em centros educativos portugueses.Ayant comme point d’analyse les politiques voyageuses, dont le processus de régulation s’observe par le changement conceptuel, nous analysons, dans ce texte, les concepts-clés de globalisation, curriculum et apprentissage, dans un contexte d’analyse critique des pratiques curriculaires en contextes différenciés, surtout de l’éducation élémentaire et de l’éducation en situations de nécessités éducatives spéciales. Comme le curriculum est un processus d’éducation et de formation, avec des perspectives très différentes, qui, de plus en plus, a sa construction de base dans le contexte de la globalisation, entendue comme un processus d’ homogénéité au niveau des similitudes définies par les politiques transnationales, comment différencier l’apprentissage au niveau des pratiques curriculaires? Pour répondre à cette question nous suivons l’analyse documentaire, surtout les documents structurants de l’organisation curriculaire portugaise et des planifications utilisés par les professeurs au niveau de l’éducation élémentaire et des nécessités éducatives spéciales et dans un contexte institutionnel des centres éducatifs portugais

Da descolonização inacabada ao limiar da independência

O “25 de Abril de 1974” encontrou o território de Timor-Leste numa situação de subdesenvolvimento, apesar das melhorias que, desde a segunda metade da década de 1960, muito por força da pressão internacional, ali haviam sido introduzidas. No entanto, a herança portuguesa revelar-se-ia a vários níveis, serviria de diferenciação dos Timorenses de Leste perante o ocupante e, em larga medida, tem sido incorporada na identidade do novo Estado. A criação de partidos políticos, com a descolonização, por falta de experiência e de verdadeiras elites, conduziu a uma cerrada luta política, que Portugal não conseguiu tutelar e que a Indonésia aproveitou para concretizar um desígnio que, desde a sua formação, animava sobretudo o sector militar. Por sua vez, a Austrália, no imediato, tentou não se comprometer directamente; mas, posteriormente, apoiou a anexação. A retirada de Portugal, sem que o processo de descolonização do território houvesse terminado, e a conjuntura internacional, possibilitaram uma anexação e uma ocupação violentas, contrariadas por uma resistência que surpreendeu o mundo. Portugal conseguiu depois, interna e externamente, manter viva a “Questão de Timor-Leste”, participando simultaneamente em conversações com a Indonésia, sob patrocínio da ONU, que culminaram com o acordo e o referendo de 1999. Entretanto, a diáspora timorense encontrou vários tipos de ajuda em Portugal, para os que ficaram e para os que procuravam outros destinos, sobretudo a Austrália. A construção do novo país tem contado com uma significativa ajuda oficial, multilateral e bilateral, da antiga Metrópole, mas também de organismos autónomos e da iniciativa privada

O papel da inovação aberta na internacionalização de empresas em rede: O caso Brasil Foods

ABSTRACTThis paper aims to propose a model for the relations between innovation activities, especially the open innovation, and the internationalization of firms in networks. The methodology is qualitative and analyzes the relationships between the processes of internationalization of firms in open innovation network. The management of innovation in companies go beyond the concept of technological innovation and building international networks is important as provision of competitive advantage. In this case study, it was noticed that a major contribution of open innovation is the increased speed of organizational learning

Government policies and Portuguese port governance in the period from 2005 to 2015

This research focuses on the effect of Portuguese government policies in portmanagement, port strategy and port performance in the period from 2005 to 2015.With the structural equation modeling, we analyzed a sample of 172 observations. Government policies influence the port sector differently. The policies adopted during the period under study produced different effects, especially the national planning policies for investments as well as the central control policy, implemented tomake operations and port labormore productive. Themain contribution of this paper resides in understanding that it is essential to ensure sustainability conditions for the national port system in an increasingly globalized market where the trend is to be less dependent on the government policies.info:eu-repo/semantics/publishedVersio

Factors associated with fruit and vegetable intake among adults of the city of São Paulo, Southeastern Brazil

OBJETIVO: Descrever a freqüência de consumo de frutas, legumes e verduras por adultos e analisar os fatores associados ao seu consumo. MÉTODOS: Estudo transversal realizado entre outubro e dezembro de 2003 no município de São Paulo (SP). Foram realizadas entrevistas telefônicas em amostra probabilística da população adulta (>18 anos) residente em domicílios servidos por linhas fixas de telefone, totalizando 1.267 mulheres e 855 homens. A freqüência do consumo de frutas, legumes e verduras foi medida por meio de um roteiro com perguntas curtas e simples. Na avaliação dos fatores associados ao consumo, realizou-se análise de regressão linear multivariada e hierarquizada, com variáveis sociodemográficas no primeiro nível hierárquico, comportamentais no segundo e relacionadas ao padrão alimentar no terceiro nível. RESULTADOS: A freqüência de consumo de frutas, legumes e verduras foi maior entre as mulheres. Para ambos os sexos, verificou-se que a freqüência desse consumo aumentava de acordo com a idade e a escolaridade do indivíduo. Entre mulheres que relataram ter realizado dieta no ano anterior houve maior consumo de frutas, legumes e verduras. O consumo de alimentos que indicam um padrão de consumo não saudável como açúcares e gorduras se mostrou inversamente associado ao consumo de frutas, legumes e verduras em ambos os sexos. CONCLUSÕES: O consumo de frutas, legumes e verduras da população adulta residente em São Paulo foi maior entre as mulheres, sendo influenciado pela idade, escolaridade e dietaOBJECTIVE: To describe the frequency of fruit and vegetable intake by adults and to assess factors associated with this frequency. METHODS: Cross-sectional study, carried out between October and December 2003 in the municipality of São Paulo, Southeastern Brazil. Telephone interviews were conducted on a probabilistic sample of the adult population (>18 years) living in the city of Sao Paulo and with access to land telephone lines, totaling 1,267 women and 855 men. Frequency of fruit and vegetable intake was obtained by means of a questionnaire containing short, simple questions. Association of different factors with fruit and vegetable intake was assessed by multivariate linear regression using a hierarchic model with sociodemographic variables in the first hierarchical level, behavioral variables in the second, and diet-related variables in the third. RESULTS: Frequency of fruit and vegetable intake was higher among women. For both sexes, frequency of intake increased with age and schooling. Intake was also higher among women who reported having been on a diet during the last year. Consumption of foods indicative of an unhealthy diet - such as sugars and fats - was inversely associated with fruit and vegetable intake among subjects of both sexes. CONCLUSIONS: Fruit and vegetable intake in the adult population of Sao Paulo was higher among women, and was influenced by age, schooling, and die